Table 2

Clinical details of patients undergoing surgical intervention

Patient	Reason for referral	EUS total	Length of EUS surveillance ⁽months)	Spigelman stage	Macroscopic ampullary disease	Ampullary polyp size (mm)	Kashiwagi classificaiton	EUS findings	Surgery	Cancer	Surgical histology	Outcome/further details
1	EUS at referring hospital suggestive of early ampullary cancer	8	89	IV	Present	40	Major	Transient small lymph nodes and CBD dilatation	Laparotomy	Ampullary	–	Last EUS confirmed ampullary adenocarcinoma on biopsy. Attempted pancreaticoduodenectomy abandoned due to extensive desmoid disease
2	High grade dysplasia in duodenal polyposis	1	–	IV	Absent	–	–	Polyp ulceration	Pancreaticoduodenectomy	Duodenal	pT3N0 duodenal adenocarcinoma	Died of metastatic duodenal cancer 3 years postoperatively
3	5 cm ampullary polyp	1	–	III	Present	57	Major	None	Pancreaticoduodenectomy	–	TVA with focal HGD	–
4	3 cm ampullary polyp	1	–	III	Present	35	Major	None	Pancreaticoduodenectomy	–	TVA with focal HGD	–
5	3 cm ampullary polyp	3	64	III	Present	15	Major	Polyp ulceration	Laparotomy	–	–	Attempted pancreaticoduodenectomy abandoned due to extensive desmoid disease. Returned to EUS surveillance
6	2.5 cm ampullary polyp	1	–	III	Present	30	Major	Double duct sign	Pancreaticoduodenectomy	–	TVA with LGD	–
7	2 cm ampullary polyp	1	–	IV	Present	10	Major	None	Total pancreatectomy, duodenectomy & splenectomy	Duodenal	Unavailable	Discharged back to referrer as desmoid disease precluded prophylactic surgery. Developed duodenal cancer 4 years after discharge. Surgery performed at other hospital. Patient died from short gut syndrome 1 year postoperatively
8	Multiple ampullary polyps	2	6	III	Present	15	Major	Transient PD dilatation	Pancreaticoduodenectomy	Ampullary	T3N1 ampullary adenocarcinoma	Developed metastatic disease 2 years postoperatively
9	Severe duodenal polyposis and 1 cm ampulla	1	–	IV	Present	15	Major	PD dilatation	Pancreaticoduodenectomy	–	TVA with focal MGD	–
10	Severe duodenal polyposis not amenable to endoscopic management	1	–	III	Present	7	Minor	None	Total pancreatectomy, duodenectomy & splenectomy	–	Widespread duodenal polyposis, no malignancy	–
11	Duodenal polyposis not amenable to endoscopic management	2	21	II	Present	“Large”	Major	None	Pancreaticoduodenectomy	Duodenal	Unavailable	Moved out of area. Developed duodenal cancer 5 years after discharge. Developed metastatic disease 2 years postoperatively
12	Severe duodenal polyposis not amenable to endoscopic management	3	21	III	Unknown	Unknown	Unknown	None	Laparotomy	–	–	Attempted pancreaticoduodenectomy abandoned due to extensive desmoid disease

Transient EUS finding defined as present in a previous EUS procedure but resolved in the last preoperative EUS.
EUS, endoscopic ultrasound;HGD, high-grade dysplasia; LGD, low-grade dysplasia; MGD, moderate-grade dysplasia; PD, pancreatic duct; TVA, tubulovillous adenoma.